刺络放血结合针灸治疗膝骨性关节炎的Meta分析

A Meta-analysis of Pricking Blood Therapy combined with Acupuncture in the Treatment of Knee Osteoarthritis

目的:系统评价刺络放血结合针灸治疗膝骨性关节炎(KAO)的疗效。方法:计算机检索中国知网(CNKI)、万方数据库、维普数据库(VIP)、Pubmed及中国生物医学文献数据库(CBM)中有关刺络放血疗法治疗KAO的临床随机对照试验文献,按拟定的纳入标准和排除标准对原始文献进行筛选,对纳入研究进行文献质量评价和Meta分析。运用Review Manager 5.3软件进行异质性检验并计算各指标的OR值和95%可信区间。结果:10篇文献纳入研究,共764例患者,其中3项为高质量研究,7项为低质量研究。刺络放血组与常规治疗组比较,总有效率及治愈率的Meta分析结果显示:[OR=4.38,95%CI(2.63,7.28),P<0.000,01]、[OR=2.40,95%CI (1.54,3.74),P=0.0001];其中7篇以VAS评分为疼痛指标的样本量为577例,治疗前后VAS差值的均差(MD)合并效应量为[MD=-1.81,95%CI(-2.33,-1.28),P<0.000,01],以上差异均有统计学意义(P<0.05),表明刺络放血配合针灸治疗KOA的疗效优于常规针刺或单纯西药治疗。结论:刺络放血结合针灸在KOA的治疗上较常规针刺或单纯西药治疗更有优势,由于纳入研究的质量普遍不高、样本量小及可能存在的偏倚等因素,尚需更多高质量及方法学规范化的随机对照研究验证。

Objective: To systematic review of the efficacy of pricking blood therapy combined with acupuncture in the treatment of knee osteoarthritis(KAO). Methods: The literatures on clinical randomized controlled trials of pricking blood therapy for KAO in CNKI, Wanfang database, VIP database, Pubmed database and CBM were searched by computer. The original literatures were screened according to the proposed inclusion and exclusion criteria, and the quality of the literatures was evaluated and Meta-analyzed. Review Manager 5.3 software was used to test the heterogeneity and calculate the OR value and 95% confidence interval of each index. Results: 10 articles were included in the study, 3 of them were high quality research and 7 were low quality research. The cure rate and the total effective rate of OR and 95% CI were: the total effective rate was[OR=4.38, 95%CI(2.63,7.28), P<0.00001], the cure rate was [OR=2.40, 95%CI(1.54, 3.74), P=0.0001]. Among them,there were 577 samples with VAS score as pain index, and the combined effect of mean deviation(MD) of VAS difference before and after treatment was [MD =-1.81, 95% CI(-2.33,-1.28), P <0.000,01], which indicated that pricking blood therapy combined with acupuncture treatment of KOA is better than conventional acupuncture or simple western medicine treatment. Conclusion: Pricking blood therapy combined with acupuncture has more advantages in the treatment of KOA than conventional acupuncture or western medicine alone. Due to the low quality, small sample size and possible bias of the included studies, more randomized controlled studies with high quality and standardized methodology are needed.